AB0644 OUTCOMES AND FACTORS PREDICTING MORTALITY IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS ADMITTED TO INTENSIVE CARE UNIT
Authors: A. Gopalan, S. C. Veeravalli
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> SLE is a chronic autoimmune disease; the course of illness is interspersed with disease flares, infections, adverse drug events which may warrant intensive care admission. Outcomes and factors affecting mortality in these patients are not well established. <h3>Objectives</h3> The primary objective is to describe the outcomes and causes of mortality of SLE patients admitted to ICU. Secondary objective is to analyse factors associated with mortality. <h3>Methods</h3> Single centre retrospective observational study from Krishna Institute of Medical Sciences, a tertiary care hospital in South India. Patient with SLE admitted to intensive care unit due to any cause between 2016 and 2021 were included. Data was collected about the characteristics of disease prior to their admission to the ICU, as well as the clinical features, laboratory values and therapeutic measures during ICU stay. Statistical analysis was done with SPSS. <h3>Results</h3> Eighty seven patients were included in the study. Mean age was 33.16 ± 12.6 years and 87% were females. Most common causes for admission were infection in 51 (58%) and disease flare-up in 31 (35%) patients; 34 (39%) patients had a combination of disease flare and infection. Mean APACHE II score at admission was 17.32 and mean SLEDAI-2k score at presentation was 15.16. The mean duration of ICU stay was 6.02 ± 6.58 days. Mechanical ventilation was needed for 45 patients (51%), inotropic support in 36 patients (41%) and dialysis in 19 patients (21%). The mortality rate was 21% (19 cases), 18/19 patients had both very high disease activity and sepsis. Factors correlating with mortality (on multivariate analysis) included higher APACHE II score at presentation, presence of fever, acute kidney injury, low serum albumin, low hematocrit, low glasgow coma scale, sepsis, need for mechanical ventilation, inotropic support and renal replacement therapy. <h3>Conclusion</h3> Mortality rate in our study population was 21%, which is in line with observed trend in last 2 decades. The leading cause of admission to ICU in our cohort was disease flare resulting from poor compliance and infections. Mortality resulted from a combination of high disease activity with infection; a difficult to manage situation for the rheumatologist and the intensivist. <h3>References</h3> [1]Ana Sua ́rez-Avellaneda et al. Systemic lupus erythematosus in the intensive care unit: a systematic review. Lupus 2020, Vol. 29(11) 1364–1376. [2]Shen H-N, Yang H-H, Lu C-L. Temporal trends in characteristics and outcome of intensive care unit patients with systemic lupus erythematosus in Taiwan: a national population-based study. Lupus 2013; 22: 644–652. [3]Cavallasca JA, Del Rosario Maliandi M, Sarquis S, et al. Outcome of patients with systemic rheumatic diseases admitted to a medical intensive care unit. J Clin Rheumatol 2010; 16: 400–402. [4]Fatemi A, Shamsaee S, Raeisi A, et al. Prognostic fac- tors of mortality in Iranian patients with systemic lupus erythematosus admitted to intensive care unit. Clin Rheumatol 2017; 36: 2471–2477. [5]Ranzani OT, Battaini LC, Moraes CE, et al. Outcomes and organ dysfunctions of critically ill patients with sys- temic lupus erythematosus and other systemic rheumat- ic diseases. Braz J Med Biol Res 2011; 44: 1184–1193. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.